Advanced Silk Fibroin/Polylactic Acid Composite Scaffolds for Bone Regeneration: A Perspective on Mechanobiology, Immunomodulation and Clinical Application

Repair of bone, ligament, tendon, and osteochondral defects remains challenging because existing grafts rarely satisfy mechanical, biological, and degradation requirements. We critically evaluate silk fibroin (SF)/polylactic acid (PLA) composite scaffolds as a complementary materials platform. The SF contributes cell-interactive chemistry, hydrophilicity, and enzymatic resorption, whereas PLA provides processability, stiffness, and prolonged structural support. We compare electrospinning, additive manufacturing, moulding, and emerging routes. The relate composition, fibre architecture, interfacial bonding, and degradation to mechanotransduction, osteogenesis, angiogenesis, and macrophage responses were also discussed. Evidence is organized across in vitro, small-animal, large-animal, and translational levels for load-bearing bone, ligament/tendon, and osteochondral repair. It also highlights reporting gaps, the absence of human clinical validation, and the need for standardized manufacturing and long-term safety testing. AI-assisted design, dynamic delivery, and immunomodulatory scaffolds are discussed as future directions rather than established clinical solutions.